The client delivered vaginally 2 hours ago after receiving an ...

[maychende]

The client delivered vaginally 2 hours ago after receiving an epidural analgesia. She has a slight tingling sensation in both lower extremities, but normal movement. She sustained a second-degree perineal laceration.
 
  Her perineum is edematous and ecchymotic. What should the nurse include in the plan of care for this client? 1. Assist the client to the bathroom in 2 hours to void.
  2. Place a Foley catheter now.
  3. Apply warm packs to the perineum three times a day.
  4. Allow the client to rest for the next 8 hours.

Question 2

A 20-week-gestation adolescent client states that it is important not to have a baby that weighs too much. She states this has been her rationale for limiting calories. Her weight has decreased from 110 pounds to 106 pounds.
 
  What would be the best nursing response? A. You are causing harm to your baby.
   B. It's OK to want a small baby when you're a teen.
   C. You shouldn't be worrying about your figure.
   D. Your baby needs adequate nutrition to develop.

[reelove4eva]

Answer to Question 1

1
Explanation: 1. This client is at risk for urinary retention and bladder overdistention. Overdistention occurs postpartum when the woman is unable to empty her bladder, usually because of trauma or the effects of anesthesia. After the effects of anesthesia have worn off, if the woman cannot void, postpartum urinary retention is highly indicative of a urinary tract infection (UTI). Assisting the client to the bathroom is the most likely intervention that will prevent urinary retention.

Answer to Question 2

D

[maychende]

TYSM

[Alyson.hiatt@yahoo.com]

Gracias!